Questionnaire/history: Incontinence when coughing, sneezing or on effort or exertion (likely to be stress urinary incontinence)? Sudden urgency and frequency and nocturia (likely to be urgency incontinence associated with overactive bladder syndrome)? Incontinence about equally with physical activity and urgency (suggesting mixed incontinence)? Incontinence without physical activity or a sense of urgency (suggesting a cause other than stress or urgency incontinence)? If incontinence not characterised by stress or urgency incontinence: Voiding difficulty (eg straining to void, sensation of incomplete emptying) (may suggesting chronic urinary retention (overflow incontinence)? Constant leakage of urine (may be intermittent if position dependent) (suggesting of a fistula (eg vesicovaginal)? Post-void dribbling, pain, urgency, frequency, recurrent urinary tract infection, vaginal discharge and dyspareunia (to consider urethral diverticulum)? Fluid intake and the amount and type of fluids (eg caffeine and alcohol)? Haematuria? Persisting bladder or urethral pain? Recurrent urinary tract infections? Effect on quality of life? How often incontinent, at what times and during which activities? Use of pads, pad size or changing of clothing? How often passes urine, including at night? Past medical history? Family history? Smoking? Drug history? Drug allergies: Examination: Weight? Abnormalities of gait? Indicators of neurological disease? Abdominal exam? Palpable bladder or mass? Pelvic examination? - Leakage from external urethral meatus when coughing with a comfortable full bladder (stress urinary incontinence is likely)? - Pelvic muscle tone and contraction during bimanual examination with contracting the pelvic floor muscles to squeeze the examining finger? 0 = No contraction (no discernible muscle contraction)? 1 = Flicker (flicker or pulsation)? 2 = Weak (increase in tension without any discernible lift)? 3 = Moderate (lifting of the muscle belly and elevation of the posterior vaginal wall)? 4 = Good (increased tension and a good contraction elevate the posterior vaginal wall against resistance (pressure by the examining finger applied to the posterior vaginal wall))? 5 = Strong (strong resistance applied to the elevation of the posterior vaginal wall (examiner's finger is squeezed and drawn into the vagina)? Pelvic organ prolapse? Urethral diverticulum? Pelvic mass? Atrophic vaginitis? Investigations: Urine dipstick analysis? Renal function? Management: Bladder diary for a minimum of 3 days (including the amount, type and timing of fluids, voided volume, frequency of micturition, episode of urgency, episode of incontinence, activities causing leakage and pad and clothing changes)? Reference(s): NICE CKS: Incontinence - urinary, in women